Influence of fellow eye on the diagnosis and classification of central serous chorioretinopathy.

PURPOSE: To assess the influence of fellow eye information on diagnosis and classification of central serous chorioretinopathy (CSCR) using multimodal imaging-based classification. METHODS: This was a retrospective, observational study including patients with CSCR with unilateral or bilateral involvement. Multimodal images of both eyes of each patient were compiled and presented to two masked retina specialists subdivided into three groups: (1) both eye data, (2) right eye data and (3) left eye data. The masked observers graded the CSCR as per the new CSCR classification into simple and complex CSCR in three different scenarios as subdivided above. Interobserver and intraobserver agreement was assessed using Cohen's kappa (95% confidence intervals). RESULTS: A total of 206 eyes of 103 patients with unilateral or bilateral CSCR were graded. We found a "strong" intraobserver and interobserver agreement when one eye versus both eye data was provided in terms of "simple CSCR" or "complex CSCR" (kappa value = 0.77 and 0.87, p < 0.001, and kappa value = 0.85 and 0.76, p < 0.001, respectively). Forty-three eyes (10.55%) showed discrepancy in classification between observers for individual eyes, whereas only 13 eyes (6.53%) showed discrepancy between observers when both eye data was provided. CONCLUSION: We conclude that fellow eye information was helpful in solving diagnostic dilemmas and reached 85% consensus in the diagnosis of CSCR between the observers. We found that information of fellow eyes led to a discrepancy only in 6.53% cases with 2.42% cases that had a controversial diagnosis of CSCR. Multimodal imaging-based CSCR classification provides objective approach to diagnose and classify CSCR.

Role of multicolour imaging in post-fever retinitis involving posterior pole.

PURPOSE: To describe composite multicolour (MC) imaging features along with the monocoloured fundus reflectance images in active and resolving stages of post-fever retinitis (PFR). METHODS: Retrospective image analysis of cases of PFR who underwent dilated retinal clinical examination followed by optical coherence tomography and MC imaging. RESULTS: Twenty-five eyes of 18 patients diagnosed with PFR were included. There were 11 males and 7 females. Mean age of patients was 30.63 years. The retinitis lesion appeared bright white on MC image and white mainly on blue and green reflectance images during the active stages of PFR. The lesion appeared dull-grey to greyish white during the resolving stages and as dull-green in resolved cases. The active stages showed the presence of intraretinal/subretinal fluid which appeared as green colour on MC images and less green to normal during resolving stages. Hard exudates were seen as bright yellow- or orange-coloured spots on MC image during the resolving stages of the disease. CONCLUSION: The different stages of PFR show different colour on multicolour image and different reflectance patterns on individual colour reflectance channels. Hence, multimodal fundus imaging with different wavelength can be helpful for differentiation of activity in PFR.

Recommendations for initial diabetic retinopathy screening of diabetic patients using large language model-based artificial intelligence in real-life case scenarios.

PURPOSE: To study the role of artificial intelligence (AI) to identify key risk factors for diabetic retinopathy (DR) screening and develop recommendations based on clinician and large language model (LLM) based AI platform opinions for newly detected diabetes mellitus (DM) cases. METHODS: Five clinicians and three AI applications were given 20 AI-generated hypothetical case scenarios to assess DR screening timing. We calculated inter-rater agreements between clinicians, AI-platforms, and the "majority clinician response" (defined as the maximum number of identical responses provided by the clinicians) and "majority AI-platform" (defined as the maximum number of identical responses among the 3 distinct AI). Scoring was used to identify risk factors of different severity. Three, two, and one points were given to risk factors requiring screening immediately, within a year, and within five years, respectively. After calculating a cumulative screening score, categories were assigned. RESULTS: Clinicians, AI platforms, and the "majority clinician response" and "majority AI response" had fair inter-rater reliability (k value: 0.21-0.40). Uncontrolled DM and systemic co-morbidities required immediate screening, while family history of DM and a co-existing pregnancy required screening within a year. The absence of these risk factors required screening within 5 years of DM diagnosis. Screening scores in this study were between 0 and 10. Cases with screening scores of 0-2 needed screening within 5 years, 3-5 within 1 year, and 6-12 immediately. CONCLUSION: Based on the findings of this study, AI could play a critical role in DR screening of newly diagnosed DM patients by developing a novel DR screening score. Future studies would be required to validate the DR screening score before it could be used as a reference in real-life clinical situations. CLINICAL TRIAL REGISTRATION: Not applicable.

Bacillary Layer Detachment in Unilateral Acute Idiopathic Maculopathy: A Report of 2 Cases.

AIM: To report the presence of bacillary layer detachment (BLD) in unilateral acute idiopathic maculopathy (UAIM). CASE DESCRIPTION: Two patients diagnosed with UAIM based on the clinical and imaging features showed the characteristic splitting of the ellipsoid layer on spectral domain optical coherence tomography (SDOCT). This has been termed as bacillary layer detachment. RESULTS: No treatment was given. In both cases, there was a complete spontaneous resolution of the SDOCT findings 14-days post-presentation in Case 1 and 5-days post-presentation in Case 2 with improvement in visual acuity to 20/20, N6 in both cases. CONCLUSION: BLD in UAIM is not a commonly reported SDOCT finding and can serve as an imaging biomarker.

Imaging characteristics of bilateral CSCR cases:12 months follow up.

PURPOSE: To report the disease pattern, progression and imaging characteristics in eyes with bilateral central serous chorioretinopathy (CSCR). METHODS: This was a retrospective case review of bilateral CSCR patients with active disease in at least one eye. Multimodal imaging including fundus photography, fundus autofluorescence, optical coherence tomography (OCT), fluorescein and indocyanine angiography (FA/ICGA) was done at baseline and follow-up visits. Disease classification was done using recently described classification criteria. The degree of asymmetry in the disease distribution pattern at baseline and disease progression during follow-up visit with a minimum duration of 12 months was studied. RESULTS: Among 103 CSCR patients, 36 patients (34.95%) with mean age of 53.6 ± 10.5 years had bilateral CSCR at baseline. Five patients (13.9%) had asymmetrical disease i.e. simple in one eye and complex in fellow eye. The remaining 31 patients had symmetric disease (simple, 2; complex 29). Mean duration of follow up was 17.58 ± 13.84 months. There was no significant difference between both eye parameters at last follow up (best corrected visual acuity, BCVA; central macular thickness, CMT; and subfoveal choroidal thickness, SFCT) (all p > 0.05). At last follow up, 22 eyes (2 simple and 20 complex) remained active whereas none of the eyes converted from simple to complex CSCR. CONCLUSION: Bilateral disease was more commonly seen with complex CSCR in contrast to simple CSCR. Moreover, disease distribution in complex CSCR had symmetric pattern if bilateral disease was present. None of the simple CSCR eyes converted to complex type.

Proliferative diabetic retinopathy detection: Comparison of clinical examination, optomap photographs and fluorescein angiography.

INTRODUCTION: This study aimed to analyse the clinical retinal examination findings and undilated Optomap ultrawide field retinal imaging for the detection of proliferative diabetic retinopathy (DR) as compared to the fluorescein angiography (FA). MATERIALS AND METHODS: In this retrospective cross-sectional study, five hundred and twenty-three patients diagnosed with diabetic retinopathy on dilated retinal examination underwent fluorescein angiography and undilated Optomap imaging. Fluorescein angiography and undilated Optomap images were graded by masked graders and the diagnosis was labelled either as proliferative diabetic retinopathy or non-proliferative diabetic retinopathy. Sensitivity and specificity was calculated comparing the diagnosis obtained from the dilated retinal examination and the undilated Optomap images against the fluorescein angiography image findings. RESULTS: Gradable quality fluorescein angiography and undilated Optomap images with a clinical diagnosis mentioned in the medical record for that particular visit were available in 980 (right eye - 656; 67%; left eye - 324; 33%) eyes of 496 patients. There were 332 (67%) males and 164 (33%) females with a mean age of 60.3 ± 9.51 years (range: 32 - 81 years). Sensitivity of clinical examination and undilated Optomap images in accurately identifying proliferative diabetic retinopathy was 63.5% and 43.5% respectively. Specificity of clinical examination and undilated Optomap images in accurately identifying proliferative diabetic retinopathy was 88.5% and 76.2% respectively. On comparison of the undilated Optomap imaging findings against the clinical examination findings, the sensitivity and specificity were 47.7% and 75.1% respectively. CONCLUSION: Both clinical fundus evaluation and undilated Optomap imaging were relatively inferior to fluorescein angiography in the detection of proliferative diabetic retinopathy, which hence remains the choice of imaging modality giving scope for wider application.

Choroidal and retinal thickness variations in anaemia and anaemic retinopathy.

Anemia is the most common hematological disorder noted in the people of the Indian subcontinent. Hemodynamic changes following anemia on the retina and choroid are not frequently studied. The aim of the study was to analyse the subfoveal retinal (CRT) and choroidal (SFCT) thickness changes in patients with anemia. In this retrospective, comparative study, patients who were diagnosed with primary anemia and had a fundus examination by a retinal specialist were included. Patients were divided into 3 groups: Group 1: Patients with anemic retinopathy; Group 2: Patients with anemia without retinopathy; Group 3: Normal healthy controls. One hundred and ninety-seven eyes of 197 subjects (group 1 - 38 eyes, group 2 - 90 eyes; group 3 - 69 eyes) met the inclusion criteria. Mean CRT was 269 ± 117µm, 258 ± 99.7µm and 201 ± 19.2µm and SFCT was 303 ± 68.4µm, 303 ± 50.1µm and 275 ± 38.9µm in groups 1, 2 and 3 respectively. Low haemoglobin corelated negatively with retinal (r = -0.362; p = <0.001) and choroidal (r = -0.294; p = <0.001) thickening and reduced visual acuity (r = -0.157; p = 0.03). In conclusion, patients with anemia have a thicker retina and choroid compared to normal healthy controls.

Visual acuity correlates with multimodal imaging-based categories of central serous chorioretinopathy.

OBJECTIVE: To evaluate visual acuity (VA) and factors influencing VA using new multimodal imaging-based classification of central serous chorioretinopathy (CSCR). METHODS: Retrospective, observational and cross-sectional study on 229 naïve eyes diagnosed as CSCR with available baseline data and multimodal imaging. Each case was classified into (i) simple/complex/atypical; (ii) primary/recurrent/resolved; (iii) persistent or not; (iv) outer retinal atrophy(ORA) present/absent; (v) foveal involvement present/absent; and (vi) macular neovascularization(MNV) present/absent. Best corrected visual acuity (BCVA) was correlated to the classification as well as every parameter of the classification. RESULTS: Median BCVA was 0.18 logMAR [95% Confidence Interval (CI)0.16-0.18] with median duration of complaints of one month (95% CI,6.14-13.0 months). Age of the patient (r = -0.24, p = 0.002) and duration of the disease (r = -0.32, p < 0.001) correlated significantly with BCVA. Logistic regression model showed that older age [odds ratio (OR) = 0.96, p = 0.05], female gender (OR = 2.45, p = 0.046), presence of ORA(OR = 0.34, p = 0.012),and foveal involvement(OR = 0.18, p = 0.007) were statistically significantly associated with poorer BCVA. Eyes classified as complex, persistent CSCR, with ORA or foveal involvement demonstrated lower BCVA compared to those with simple, non-persistent CSCR, without ORA or without foveal involvement (p < 0.05). Eyes with complex CSCR (p < 0.001), atypical CSCR(p = 0.025), persistent subretinal fluid (SRF) (p = 0.001) and those with ORA (p < 0.001) demonstrated a trend towards severe visual loss. Prevalence of persistent SRF, recurrent episodes and ORA was significantly higher among eyes with complex CSCR (p < 0.001) while there was no difference in prevalence of resolved cases (p = 0.07), foveal involvement (p = 0.28) and MNV (p = 0.45) between simple and complex cases. CONCLUSION: There is a strong correlation between VA and foveal involvement and ORA using the new classification. Thus, the objective parameters of the classification can be incorporated in establishing the treatment guidelines for CSCR.

Rare presentation of choroidal neovascularisation in a case of congenital hypertrophy of retinal pigment epithelium.

A 22-year-old woman presented with a 2-week history of decreased vision, a central scotoma and metamorphopsia in her right eye. Her presenting visual acuity was 6/75 in the right eye and 6/6 in the left eye. Anterior segment examination was normal. Fundus examination of both eyes showed features of bilateral congenital hypertrophy of retinal pigment epithelium (CHRPE) lesions and choroidal neovascularisation (CNV) in the right eye. She was treated with intravitreal injection bevacizumab 1.25 mg/0.05 mL. One month later, there was regression of the CNV and subretinal fluid and her vision improved to 6/12. At the final follow-up visit, her vision was maintained at 6/9 with regression of CNV noted. To conclude, CNV is a rare association of CHRPE. It can lead to vision-threatening problem if it involves the macula and should be identified promptly and managed appropriately.